Patients with hepatocellular carcinoma in intensive care unit

Abstract

Hepatocellular carcinoma (HCC) is the most frequent primary liver tumor. It develops in 90% of the cases on a chronic liver disease at the stage of cirrhosis. HCC is associated with a poor prognosis due to a frequent late diagnosis at advanced stages. The indications for treatment are guided according to the BCLC staging system, which takes into account tumor burden (number of nodules, size, vascular invasion and extrahepatic metastasis), liver function and performance status. Curative treatments are percutaneous ablation, surgical resection and liver transplantation. The expected overall survival is more than 5 years with theses treatments. Palliative treatments are composed of intra-arterial treatments (chemo and radioembolization) and systemic therapies (atezolizumab/bevacizumab, tyrosine kinase inhibitors). The overall survival depends on the tumoral response to these treatments and are around 30 months for intra-arterial treatments and 16 to 20 months for systemic treatments. Complications related to cirrhosis (variceal bleeding), to HCC itself (tumoral bleeding) or to HCC treatments can require management in intensive care unit. The discussion of transfer to intensive care unit should be based on tumor stage, expected life expectancy, reversibility of the complication, liver transplantation indication and patient’s comorbidities.